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  • Title: Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors.
    Author: Raghunath AS, Hungin AP, Mason J, Jackson W.
    Journal: Aliment Pharmacol Ther; 2009 Feb 15; 29(4):431-9. PubMed ID: 19035981.
    Abstract:
    BACKGROUND: Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. AIM: To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. METHODS: A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. RESULTS: Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. CONCLUSIONS: A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients.
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